nach oben

Social Psychiatry and Psychiatric Epidemiology

Erschienen in:

18.03.2021 | Review

Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia

verfasst von: Akmal-Alikhan Aliev, Tessa Roberts, Shakhnoza Magzumova, Liliia Panteleeva, Saida Yeshimbetova, Dzmitry Krupchanka, Norman Sartorius, Graham Thornicroft, Petr Winkler

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 8/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

We aimed to map evidence on the development of mental health care in Central Asia after 1991.

Method

We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications.

Results

We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990’s mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments.

Conclusions

There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.

Nur mit Berechtigung zugänglich

World Bank. https://data.worldbank.org/?locations=UZ-KZ-TJ-KG-TM. Accessed Nov 29, 2019)

Tomov T, Van Voren R, Keukens R, Puras D (2006) Mental health policy in former eastern bloc countries. Mental health policy and practice across Eur Fut Direct Mental Health Care:397–426

McKee M (2007) Cochrane on communism: the influence of ideology on the search for evidence. Int J Epidemiol 36(2):269–273PubMedCrossRef

Höschl C, Winkler P, Peěč O (2012) The state of psychiatry in the Czech Republic. Int Rev Psychiatry 24(4):278–285PubMedCrossRef

Rechel B, Ahmedov M, Akkazieva B, Katsaga A, Khodjamurodov G, McKee M (2011) Lessons from two decades of health reform in Central Asia. Health Policy Plan 27(4):281–287PubMedCrossRef

Rechel B, Roberts B, Richardson E, Shishkin S, Shkolnikov VM, Leon DA, Bobak M, Karanikolos M, McKee M (2013) Health and health systems in the Commonwealth of Independent States. The Lancet 381(9872):1145–1155CrossRef

McKee M, Figueras J, Chenet L (1998) Health sector reform in the former Soviet Republics of Central Asia. Int J Health Plann Manage 13(2):131–147PubMedCrossRef

Winkler P, Krupchanka D, Roberts T, Kondratova L, Machů V, Höschl C, Sartorius N, Van Voren R, Aizberg O, Bitter I, Cerga-Pashoja A, Deljkovic A, Fanaj N, Germanavicius A, Hinkov H, Hovsepyan A, Ismayilov FN, Ivezic SS, Jarema M, Jordanova V, Kukić S, Makhashvili N, Šarotar BN, Plevachuk O, Smirnova D, Voinescu BI, Vrublevska J, Thornicroft G (2017) A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. The Lancet Psychiatry 4(8):634–642. https://doi.org/10.1016/S2215-0366(17)30135-9CrossRefPubMed

Misra S, Stevenson A, Haroz EE, de Menil V, Koenen KC (2019) ‘Global mental health’: systematic review of the term and its implicit priorities. BJPsych Open 5 (3)

10.

European Observatory Health Policy Series (2014) In: Rechel B, Richardson E, McKee M (eds) Trends in health systems in the former Soviet countries. European Observatory on Health Systems and Policies© World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies). Copenhagen (Denmark),

11.

Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8(1):19–32. https://doi.org/10.1080/1364557032000119616CrossRef

12.

Levac D, Colquhoun H, O’Brien KK (2010) Scoping studies: advancing the methodology. Implement Sci 5(1):69PubMedPubMedCentralCrossRef

13.

WHO-AIMS Report on mental health system in Uzbekistan (2007) WHO and ministry of Health. Tashkent, Uzbekistan

14.

WHO-AIMS Report on Mental Health System in Kyrgyzstan (2008) WHO and ministry of health. Kyrgyz Republic, Bishkek

15.

WHO-AIMS Report on Mental Health System in Tajikistan (2009) WHO and ministry of health. Dushanbe, Tajikistan

16.

Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L (2011) Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(10):718–779PubMedCrossRef

17.

Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T (2015) The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS One 10(2):e0116820PubMedPubMedCentralCrossRef

18.

Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol 43(2):476–493PubMedPubMedCentralCrossRef

19.

Kolves K, De Leo D (2014) Suicide rates in children aged 10–14 years worldwide: changes in the past two decades. Br J Psychiatry 205(4):283–285PubMedCrossRef

20.

Stickley A, Koyanagi A, Richardson E, Roberts B, Balabanova D, McKee M (2013) Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union. BMC Comp Altern Med 13(1):83CrossRef

21.

Murthy RS (2011) Mental health services in low-and middle-income countries. Oxford Textbook of community mental health:325–338

22.

Gale NK, Heath G, Cameron E, Rashid S, Redwood S (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 13(1):117PubMedPubMedCentralCrossRef

23.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169(7):467–473. https://doi.org/10.7326/m18-0850CrossRefPubMed

24.

Nurmagambetova S, Assimov M (2016) State of mental health care in the Republic of Kazakhstan. Bhugra, Dinesh [Ed]; Tse, Samson [Ed]; Ng, Roger [Ed]; Takei, Nori [Ed] (2016) Routledge handbook of psychiatry in Asia (pp 7–10) xxi, 324 pp New York, NY, US: Routledge/Taylor & Francis Group; US:7–10

25.

Molchanova E, Kirn E, Galako T (2016) Psychiatry in the Kyrgyz Republic: In: Bhugra D, Tse S, Ng R, Takei N (eds) Between the Soviet past and a vague future. Routledge handbook of psychiatry in Asia. Routledge/Taylor & Francis Group, New York, xxi, 324. pp 11–17

26.

Kharabara G, Khodjaeva N (2016) State of mental health care in the Republic of Uzbekistan. In: Bhugra, D, Tse S, Ng R, Takei N (eds) Routledge handbook of psychiatry in Asia. Routledge/Taylor & Francis Group, New York, xxi, 324, 27–32

27.

Mamedkuliev C, Shevkun E, Hajioff S (2000) Health care systems in transition: turkmenistan. European Observatory on Health Care Systems, Copenhagen

28.

Molchanova E (2014) Mental health rehabilitation in the kyrgyz republic: official and indigenous models. J Psychosoc Rehab Mental Health 1(1):23–26CrossRef

29.

Sadykov E, Hosak L (2016) Péče o duševně nemocné v Kyrgyzstánu [Mental health care in Kyrgyzstan]. Ceska Slov Psychiatr 112(1):31–35

30.

Latypov A (2010) Healers and psychiatrists: the transformation of mental health care in Tajikistan. Transcult Psychiatry 47(3):419–451PubMedCrossRef

31.

Veeken H (1997) Tajikistan: no pay, no care. BMJ 315(7120):1460–1461PubMedPubMedCentralCrossRef

32.

Mukhamadiev D, Muminova R (2011) Organizatsionnyye problemy psikhicheskogo zdorov'ya v Tadzhikistane [Organisational problems of mental health in Tajikistan]. Vestnik psikhiatrii i psikhologii Chuvashii [Bulletin of psychiatry and psychology of Chuvashia] (7)

33.

Latypov A, Magkoev V, Vohidova M, Nisanbaeva Z (2007) Mental health services in Tajikistan. Int Psychiatry 4:66–69. https://doi.org/10.1192/S1749367600001946CrossRef

34.

Baibabayev A, Cunningham D, De Jong K (2000) Update on the state of mental health care in the Republic of Tajikistan. Mental Health Reforms 5(3):14–16

35.

Mundt A, Heinz A, Strohle A (2009) Uzbekistan: psychiatry in transition. Eur Psychiatry 24(8):526–528PubMedCrossRef

36.

Gazizova D, Mazgutov A, Kharabara G, Tsoyi E (2011) Mental health in Uzbekistan. Int Psychiatry 8:10–11. https://doi.org/10.1192/S1749367600006160CrossRefPubMedPubMedCentral

37.

Rechel B, McKee M (2005) Human rights and health in Turkmenistan. European Centre on Health and Societies in Transition, London School of Hygiene and Tropical Medicine

38.

Petrea I (2012) Mental health in former Soviet countries: from past legacies to modern practices. Public Health Rev 34(2):5CrossRef

39.

WHO (2019) Closing the mental health treatment gap in Central Asia. World Health Organisation. http://www.euro.who.int/en/countries/kyrgyzstan/news/news/2019/6/closing-the-mental-health-treatment-gap-in-central-asia?fbclid=IwAR20LiMjo1ZL1AirHhndmDk32XSLVGfdJLsu2HYFaZJ93AUgamiB9y97TG4.

40.

Itogi realizatsii zakona respubliki Uzbekistan (2016) O psikhiatricheskoy pomoshchi za istekshiye 16 let [Results of the implementation of the law of the Republic of Uzbekistan 'On psychiatric care' for the past 16 years]. Nauchno-Prakticheskiy Medicinskiy Zhurnal [Scientific Practical Medical Journal] (4)

41.

Kurbanova SM, Harabara GI (2017) About the measures taken to improve the mental health service in the Republic of Uzbekistan for 2013–2016. Zh Nevrol Psikhiatr Im S S Korsakova 117(5):114–116PubMedCrossRef

42.

Prava lits, nakhodyashchikhsya v Respublikanskoy psikhiatricheskoy bol'nits [Human Rights in the Republican Psychiatric Hospital ] [Russian] (2017). Ombudsman of the Kyrgyz Republic, Bishkek

43.

Dorozhnaya karta po razvitiyu sluzhby okhrany psikhicheskogo zdorov'ya Respubliki Kazakhstan na 2019–2020 gody [The Roadmap of Development of Mental Health Care of the Republic of Kazakhstan for 2019–2020]. (2019) Ministry of Health Care of the Republic of Kazakhstan. http://www.rcrz.kz/files/DK2019/3.%20%D0%94%D0%9A%20%D0%BF%D1%81%D0%B8%D1%85%20%D1%80%D1%83%D1%81.pdf. Accessed 16 Dec 2020

44.

Programma Pravitel'stva Kyrgyzskoy Respubliki po okhrane psikhicheskogo zdorov'ya naseleniya Kyrgyzskoy Respubliki na 2018–2030 gody [The Programme of the Government of the Kyrgyz Republic on the Protection of the Population's Mental Health for the 2018–2030]. (2018). http://cbd.minjust.gov.kg/act/view/ru-ru/11840. Accessed 16 Dec 2020

45.

Kontseptsiya razvitiya sluzhby okhrany psikhicheskogo zdorov'ya naseleniya Respubliki Uzbekistan na 2019–2025 gody [The Concept of Development of Mental Health Care in the Republic of Uzbekistan for the years 2019–2025]. (2019). https://lex.uz/ru/docs/4201083. Accessed 16 Dec 2020

46.

Krupchanka D, Winkler P (2016) State of mental healthcare systems in Eastern Europe: do we really understand what is going on? BJPsych Int 13(4):96–99PubMedPubMedCentralCrossRef

47.

Mundt AP, Fakhriddinov S, Fayzirahmanova M, Aichberger MC, Ivens S, Schouler-Ocak M, Grohmann R, Magzumova S, Heinz A, Sartorius N, Strohle A (2011) Use of psychiatric inpatient capacities and diagnostic practice in Tashkent/Uzbekistan as compared to Berlin/Germany. Soc Psychiatry Psychiatr Epidemiol 46(12):1295–1302PubMedCrossRef

48.

Tomov T (2001) Mental health reforms in Eastern Europe. Acta Psychiatr Scand 104:21–26. https://doi.org/10.1034/j.1600-0447.2001.1040s2021.xCrossRef

49.

Morozov PV, Voloshyn PV, Maruta NA, Neznanov NG, Petrova NN, Altynbekov SA, Hotineanu MA, Galako TI, Skugarevskiy OA, Soghoyan A, Melik-Pashayan A, Ismayilov NV, Chkoniya E, Alimov UK, Khodjaeva NI, Ashurov ZS, Evsegneev RA, Kozhina AM, Korostiy VI (2015) Professional’naya podgotovka vrachey psikhiatrov v stranakh Vostochno-Yevropeyskogo regiona Vsemirnoy psikhiatricheskoy assotsiatsii: problemy i resheniya [Training of psychiatrists in the Eastern European region of the World Psychiatric Association: problems and solutions]. Psikhiatriya i psikhofarmakoterapiya 17(4):4–8

50.

Katkov AL, Dzharbusynova BB (2006) Mental health of the population of the Republic of Kazakhstan (based on a comprehensive study in 2003). Pavlodar

51.

Altynbekov KS, Negay NA (2015) Analiz statisticheskikh dannykh lits s diagnozom «shizofreniya» v Respublike Kazakhstan za period s 2006 po 2008 gody [Analysis of statistical data of people with diagnosis “schizophrenia” in Republic of Kazakhstan for the periodsince 2006 till 2008 years]. Obozrenie Psikhiatrii i Meditsinskoi Psikhologii im VM Bekhtereva 3:32–36

52.

Morozov PV, Neznanov NG, Limankin OV, Voloshyn PV, Maruta NA, Altynbekov SA, Hotineanu MA, Galako TI, Skugarevskiy OA, Soghoyan A, Ismayilov NV, Chkoniya E, Alimov UK, Khodjaeva NI (2014) Sostoyaniye psikhicheskogo zdorov’ya naseleniya i tendentsii razvitiya psikhiatricheskoy pomoshchi na postsovetskom prostranstve [Mental health conditions of the population and tendencies of development of mental health care in post-soviet countries]. Psikhiatriya i Psikhofarmakoterapiya 16(6):4–10

53.

Molchanova E, Panteleeva L, Popkov M, Nelubova T (2011) Dinamika urovnya mezhetnicheskoy napryazhennosti, obrazovannosti «sebya» i «drugogo» naseleniya goroda v period s oktyabrya 2010 po fevral' 2011 goda [Comparison of levels of interethnic tension and semantic images of the ‘self’and the ‘other’in periods of October 2010 and February 2011 among Osh citizens] [Russian]. Electron J Med Psychol Rus (5)

54.

Semenova Y, Pivina L, Manatova A, Bjorklund G, Glushkova N, Belikhina T, Dauletyarova M, Zhunussova T (2019) Mental distress in the rural Kazakhstani population exposed and non-exposed to radiation from the Semipalatinsk Nuclear Test Site. J Environ Radioact 203:39–47PubMedCrossRef

55.

Turgunova L, Laryushina Y, Turmukhambetova A, Koichubekov B, Sorokina M, Korshukov I (2017) The incidence of depression among the population of central kazakhstan and its relationship with sociodemographic characteristics. Behav Neurol (2584187)

56.

Otchet po issledovaniyu ekonomicheskoy effektivnosti modeli mezhdistsiplinarnykh komand, predostavlyayushchikh uslugi psikhicheskogo zdorov'ya na urovne soobshchestv [Report on the study of cost-effectiveness of community-based multisciplinary teams] (2018). Public Fund 'Institute of Social Development',

57.

Shakerimova ZS, Nussupova AS, Burambaeva MN, Yermanov ZR, Emreyeva AE, Janseitova SS (2016) Psychotherapeutic function of the Kazakh traditional music. Int J Environ Sci Edu 11(17):10321–10335

58.

Penkala-Gawęcka D (2013) Mentally ill or chosen by spirits?‘Shamanic illness’ and the revival of Kazakh traditional medicine in post-Soviet Kazakhstan. Cent Asian Surv 32(1):37–51CrossRef

59.

Molchanova E, Horne S, Kim E, Yarova O (2018) Hybridized indigenous healing in the Kyrgyz Republic: helping survivors of violence. Women Therapy 41(1–2):69–82. https://doi.org/10.1080/02703149.2017.1324187CrossRef

60.

Molchanova E, Aitpaeva G, Ten V, Koga P (2009) Integrating health systems in Kyrgyzstan: traditional healing and mainstream psychiatry. Acad J His Psychol Soc Mos 1:34–42

61.

Koen BD (2013) “My heart opens and my spirit flies”: musical exemplars of psychological flexibility in health and healing. Ethos 41(2):174–198. https://doi.org/10.1111/etho.12014CrossRef

62.

Koen BD (2006) Musical healing in eastern Tajikistan: transforming stress and depression through falak performance. Asian Music 37(2):58–83. https://doi.org/10.1353/amu.2007.0006CrossRef

63.

Penkala-Gawęcka D, Organization WH (2017) Perceptions of health and illness, and the role of healers in Kyrgyzstan. Public Health Panorama 3(1):80–87

64.

Buckley C (1997) Suicide in post-Soviet Kazakhstan: role stress, age and gender. Cent Asian Surv 16(1):45–52CrossRef

65.

Haarr RN (2012) Child suicide in Kazakhstan. Special Report. United Nations Children’s Fund

66.

Sarchiapone M (2014) Study on prevalence, underlying causes, risk and protective factors in respect to suicides. UNICEF

67.

Wasserman C, Darky T (2014) Assessment of suicide preventative activities in Kazakhstan: Kyzylorda and East Kazakhstan regions. UNICEF

68.

Haarr RN (2010) Suicidality among battered women in Tajikistan. Violence Against Women 16(7):764–788PubMedCrossRef

69.

Khodjaeva DN, Kharabara GI, Akhmedov SA (2001) Suicide prevention in Uzbekistan. Mental Health Reforms 6(2):16–17

70.

Polozhy BS (2014) Dinamika suitsidal'noy situatsii v stranakh postsovetskogo prostranstva(s 1990 g. po nastoyashcheye vremya) [Dynamics of suicidal situation in countries of post-Soviet space (1990-present)]. Psikhiatriya i psikhofarmakoterapiya 16 (2):44–47

71.

Sharygin EJ, Guillot M (2013) Ethnicity, russification, and excess mortality in Kazakhstan. Vienna Yearb Popul Res 11:219–246. https://doi.org/10.1553/populationyearbook2013s219CrossRefPubMedPubMedCentral

72.

Toktosunov E (2001) Self-help union in the Kyrgyz Republic. Mental Health Reforms 6(3):2–3CrossRef

73.

Davidoff V, Roache M, Van Voren R (2017) Psychiatry as a Tool for Coercion in Post-Soviet Countries 2012–2017. Human Rights in Mental Health–FGIP

74.

Van Voren R (2016) Ending political abuse of psychiatry: Where we are at and what needs to be done. BJPsych Bull 40(1):30–33PubMedPubMedCentralCrossRef

75.

The World Health Report (2001) Mental health: new understanding, new hope. World Health Organization

76.

Thornicroft G, Tansella M (2013) The balanced care model for global mental health. Psychol Med 43(4):849–863PubMedCrossRef

Titel: Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia
verfasst von: Akmal-Alikhan Aliev
Tessa Roberts
Shakhnoza Magzumova
Liliia Panteleeva
Saida Yeshimbetova
Dzmitry Krupchanka
Norman Sartorius
Graham Thornicroft
Petr Winkler
Publikationsdatum: 18.03.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 8/2021
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-021-02064-2

Perceived colorism and lifetime psychiatric disorders among Black American adults: findings from the National Survey of American Life

Brief report

Psychiatric hospital reform in low- and middle-income countries: a systematic review of literature

Open Access
Review

Experiences of living with mental health problems during the COVID-19 pandemic in the UK: a coproduced, participatory qualitative interview study

Open Access
COVID-19
Original Paper

Symptomatic, functional and service utilization outcomes of migrants with a first episode of psychosis

Original Paper

Early predictors for late hospitalizations up to 14 years after first episode psychosis

Open Access
Original Paper

A comprehensive model of predictors of quality of life in older adults with schizophrenia: results from the CSA study

Original Paper

Neu im Fachgebiet Psychiatrie

Einer von sieben Frauen macht die Menopause sehr zu schaffen

15.01.2025
Menopause
Nachrichten

Von mäßigen bis schweren vasomotorischen Beschwerden sind 14,7% der Frauen in der Postmenopause betroffen. Das haben kanadische Forscherinnen in einer Subgruppenanalyse der WARM-Studie herausgefunden.

Depressive Senioren fahren besonders riskant

14.01.2025
Altersdepression
Nachrichten

Beim Autofahren machen ältere Depressive häufiger eine Vollbremsung, gehen öfter zu schnell in Kurven und halten sich seltener an Tempolimits als Senioren ohne Depression. Offenbar scheint eine Depression eine riskante Fahrweise im Alter zu verstärken.

Verhaltenstherapie plus Stimulanz reduziert Binge Eating

14.01.2025
Binge-Eating-Störung
Nachrichten

Die Kombination von kognitiver Verhaltenstherapie plus Lisdexamfetamin bringt Personen mit Binge-Eating-Störung deutlich häufiger in Remission als die jeweiligen Einzeltherapien. Zudem nimmt das Gewicht der Betroffenen spürbar ab.

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia